1669641908 NPI number — MISS TAMARA DANIELLA JACHIMOWICZ

Table of content: MISS TAMARA DANIELLA JACHIMOWICZ (NPI 1669641908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669641908 NPI number — MISS TAMARA DANIELLA JACHIMOWICZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACHIMOWICZ
Provider First Name:
TAMARA
Provider Middle Name:
DANIELLA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669641908
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
277 WASHINGTON AVE
Provider Second Line Business Mailing Address:
APT. 6H
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11205-4204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-626-6963
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 W 57TH ST
Provider Second Line Business Practice Location Address:
11TH F.LOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10019-3320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-632-4486
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)